EDUCATIONAL INTERVENTION TO IMPROVE PRESCRIBING HABITS OF PEDIATRICIANS IN TREATMENT OF UNCOMPLICATE

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EDUCATIONAL INTERVENTION TO IMPROVE PRESCRIBING
HABITS OF PEDIATRICIANS IN TREATMENT OF
UNCOMPLICATED ACUTE UPPER RESPIRATORY TRACT
INFECTION Ziganshina LE, Pikuza OI, Magsumova
DR, Galyautdinova AYu. Kazan State Medical
Academy and Kazan State Medical University,
Russia
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Study questions

• To analyze the pattern of drug prescribing in
  children with acute upper respiratory tract
  infection and acute bronchitis in outpatient
  clinics of Kazan in 1998, 2000, 2002 in
  retrospective studies
• To assess the appropriateness of drug use to
  update practical guidelines
• To assess the impact of educational intervention
  on prescribing habits of pediatricians in
  pharmacotherapy of acute uncomplicated upper
  respiratory tract infections.

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Methods

• 7 outpatient clinics of Kazan in 1998.
• The period of education for the practicing
  physicians in 1999-2000 followed (evaluation
  planned).
• Pharmacotherapy courses (problem based
  pharmacotherapy teaching methodology).
• The subsequent pharmacoepidemiological survey was
  performed in 2000 and 2002.
• Out-patient medical charts of 750 children with
  uncomplicated acute upper respiratory tract
  infections were randomly chosen
• in 1998 472 cases,
• in 2000 491 cases,
• in 2002 288 cases.
• The number of prescribed drugs per case,
  antibiotics, dosage regimens were studied

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The number of prescriptions (medicines) per case
for treatment of acute respiratory infections in
children in Kazan. 1998, 2000, 2002 ( SE)

• SE Standart Error, plt0,05
  plt0,01.

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• Figure 1. Prescription of antibacterial drugs
  for treatment of acute respiratory infection in
  children in 1998 in Kazan
• (??C classification) .J01C - beta-lactams
  J01FA - macrolides J01FF - lincosamides J01E -
  sulfonamides and trimothoprim, J01A -
  tetracyclines J01G - aminoglycosides J01MA -
  fluoroquinolones. 1 - oxacillin, 2 -
  benzylpenicillin, 3 - ampicillin/ oxacillin, 4 -
  spiramycin.

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• Figure 2 Prescription of antibacterial drugs for
  treatment of acute respiratory infections in
  children in 2000 in Kazan
• (ATC classification) .J01C - beta-lactames
  J01FA - macrolides J01FF - lincosamides J01E -
  sulfonamides and trimothoprim, J01A
  tetracyclines J01G - aminoglycosides J01MA -
  fluoroquinolones. 1 - oxacillin, 2
  benzylpenicillin.

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• Figure 3. Prescription of antibacterial drugs
  for treatment of acute respiratory infections in
  children in 2002 in Kazan
• (ATC classification) J01C - beta-lactams J01FA
  - macrolides J01FF - lincosamides J01E -
  sulfonamides and trimothoprim, J01A
  tetracyclines J01G - aminoglycosides J01MA -
  fluoroquinolones. 1 - oxacillin, 3 -
  ampicillin/oxacillin, 5 - midecamycin.

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Discussion

• The antibiotics are needlessly overused in
  treatment of acute upper respiratory tract
  infection in children.
• The educational intervention based on the results
  of pharmacoepidemiological monitoring was an
  effective measure to improve the prescribing
  habits of practitioners (antibiotic use
  65.72.2 (1998) ? 35.22.2 (2000) ? 31.32.7
  (2002)).
• Despite of achieved results the usage of
  inappropriate toxic medications and wrong dosage
  regimes persisted.
• This proves the necessity of furthering
  educational interventions for primary care
  physicians and the importance of further
  pharmacoepidemiological monitoring in this field.

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Conclusion

• A problem-based educational intervention proved
  to be an effective tool to improve the
  prescribing habits of practicing physicians, and
  pharmacoepidemiological monitoring is important
  for furthering the educational impact on
  prescribing.

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Conclusion 2

• Strength
• Choice of pharmacoepidemiological methodology for
  evaluation of the educational impact
  (retrospective study, medical charts)
• Weaknesses
• Medical charts practitioners prescribing
  habits only
• No information on the actual consumption of
  medicines
• What to do next
• Evaluate drug consumption
• Pharmacies
• Patients
• Monitor drug use and educate on regular basis